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ECTRICAL PERMIT A� �ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��, p�� � �YC �- �- � �►��� (1lJ(A" �� Z L� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z �C�� . •`y" <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): ��"" ��'� <br /> DESCRIPTION OF WORK: Nr�v � � or� <br /> CONTACT INFORMATION <br /> OWNER NAME: �-Y��/`� C-�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET � � - � T ��� �e S• �� <br /> CITY � ��C.� STATE �� ZIP ��/Cr��� <br /> OWNER PHONE: Z. - UZ-Z��� 1 OWNER EMAIL: <br /> CONTRACTOR NAME: M � �'�C�^lC �-tn�- <br /> CONTRACTOR ADDRESS: sTReeT � �C� GC�^ {�lh�. SE <br /> CITY L�T�� S�4�1� STATE W� ZIP ��V <br /> CONTRACTOR PHONE: �1ZS��j�"�C" �� �l CONTRACTOR EMAIL: ��'J � e "�Yl� � u;� � LL�✓"� <br /> CONTRACTOR LIC.#(REQUIRED): L^ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z-� — ��L � - Z`i�-(� <br /> �,"�(/�N C�-� J�+ CONTACT EMAIL: <br /> AGREEMENT:T hereby cerfify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing ihis <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with ihe State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FE <br /> � DD .�°� <br /> PERMIT# <br /> �`-, - C �; �� �� �� � <br /> wner/Authorized gent Signature Date (Revised 10/12/2095J <br />